Minimally invasive surgical techniques can offer the potential for reliable cancer control with minimal impact on post treatment function of the diseased organ. There have been certain advances in providing instrumentation for minimally invasive surgery of many diseases. Although the use of CO2 lasers has become well established and can be considered to be as effective and precise scalpel, it is likely still largely limited to operations where the surgeon has unobstructed access to the tissue. (See, e.g., Polanyi, Bredemei. Hc et al. 1970; Jako 1972; Mihashi, Jako et al. 1976; Garden, Obanion et al. 1988). A particular advantage of the CO2 laser over other lasers can be that it can be readily absorbed by water, which is the primary component of most biological tissues. This can facilitate minimal thermal spread and injury to adjoining normal tissue, making the CO2 laser especially useful for surgery near critical anatomical structures, for example.
The CO2 laser can also be used to seal small blood vessels and lymphatics, likely minimizing bleeding and risk of lymphatic metastases from tumors. With the appropriate surgical optics, the tissue interaction of the CO2 laser can be used advantageously for a precise excision of a tumor with minimal injury to normal tissue so as to likely preserve function without compromising the cure. However, an exemplary disadvantage of the CO2 laser can be related to its beam's likely inability to travel in any medium other than air. Since the CO2 laser beam is likely unable to be transmitted along glass or conventional optical fibers, its use has probably been generally restricted to “line-of-sight” applications, in which it can be passed down a hollow, air-filled, straight rigid instrument or endoscope. Thus, endoscopic applications of this technique and the CO2 laser has likely been restricted to treatment of tumors of the mouth, pharynx, larynx and cervix, for example.
Further, a delivery of any type of surgical laser light into a body cavity by means fiber optics has likely been limited to use in the near field, e.g., by bringing the distal tip of the fiberoptic close to the tissue in order to keep the power density high. It can be very difficult to facilitate a flexible, variable and accurate maneuvering of such laser beam.
Instrumentation for endoscopic applications of the CO2 lasers and other surgical lasers has undergone refinement and improvement, but access to the larynx and pharynx in certain patients with adverse anatomic features has likely continued to pose a problem. This limitation of the conventional technology can be largely responsible for the potential benefits of certain surgery being denied to a large number of patients, such as patients whose tumors can be relatively difficult to access for surgical resection with endoscopic CO2 laser instrumentation, for example. Consequently, many of these patients have been treated using non-surgical options, including radiation with or without chemotherapy, to avoid the potentially devastating effects that conventional surgery can have on a patient's quality of life. However, the use of such non-surgical “organ preserving” approaches can likely often cause permanent and significant side effects that can drastically alter the lives of patients who survive after treatment.
Currently, one of the more widely used delivery methods for the CO2 lasers (and other lasers) in surgery is likely a “line-of-sight” system that may include a laser source that can deliver energy to a micromanipulator coupled to an operating microscope via an articulated arm. For example, a hollow core fiber optic delivery systems for CO2 surgical lasers which can facilitate providing a laser beam into a confined space has been described by Hart Temelkuran et al. (See, e.g., Temelkuran, Hart et al. 2002). As described, the fiber can transmit the light from the laser source to its distal end that can be used as a “laser scalpel.” However, the use of the fiber delivery techniques are likely not ideal as they can have some of the limitations of line-of-sight technologies. Additionally, fiber delivery techniques can introduce certain other problems.
For example, similarly to line-of-sight delivery techniques, it can be important to externally manipulate an apparatus using fiber delivery techniques if it is to be used in confined spaces. Additionally, because the laser beam exiting the fiber can rapidly diverge, the fiber likely should be precisely placed near the tissue in order to incise or ablate the tissue. If the fiber is placed too far away (e.g., over one millimeter), the power density can likely drop, and the laser scalpel can become ineffective. However, if the fiber tip touches the tissue, it can burn and/or become obstructed. Further, a precise manipulation of the working end of the fiber inside a body cavity can be challenging for the endoscopic surgeon due to the difficulty of maintaining a consistent depth of incision with the laser directed through a hand held fiber moving over an uneven tissue surface in a confined closed space. Moreover, a complex electro-mechanical system should likely need to be provided for the laser beam to be controlled remotely.
Certain scanners having dimensions that can likely be appropriate for endoscopic use have been described. (See, e.g., Fountain and Knopp 1992; Dohi, Sakuma et al. 2003; Wu, Conry et al. 2006; and Tsia, Goda et al. 2009). Many of these devices can be instruments that have likely been initially designed specifically for endoscopic imaging, and only subsequently were considered for use in performing tissue modification and altered to accordingly. However, the technical requirements of imaging scanners and surgical laser scanners are generally not the same, but rather can be very different. While imaging scanners generally can require regular scanning patterns to generate the image, surgical laser scanners generally can utilize random and precise variations of the scanners to address the discrete adjacent and distant points that can be involved in a typical laser surgery pattern. Thus, conventional apparatuses provided for surgery are described as having the optics and mechanical control of the scanners external to the body. (See, e.g., Fountain and Knopp 1992). Endoscopic devices have been described with optics designed to be inserted into the body, but with the mechanical control external to the body. (See, e.g., Dohi, Sakuma et al. 2003; Wu, Conry et al. 2006). These systems have certain limitations and associated problems such as spatial and temporal inaccuracies associated with the remote transmission of positioning forces from the external motors to the internal optics. Additionally, an imaging apparatus can be provided that can be used for laser surgery, in principle, purportedly without mechanical movements and that can be internalized. (See, e.g., Tsia, Goda et al. 2009). However, this device requires a tunable laser, and thus would likely not be able to work with surgical lasers like a CO2 laser, for example.
Accordingly, there may be a need to address and/or overcome at least some of the above-described deficiencies and limitations, and to provide exemplary embodiments of arrangement and method according to the present disclosure as described in further detailed herein.